§ 9789.12.3 Status Codes C, I, N and R


Effective January 1st, 2014, the California Division of Workers’ Compensation (DWC) adapted Medicare CPT/HCPCS Status Codes to further provide reimbursement information for various Procedure Codes.

Section 9789.12.3 mandates specific guidelines for status codes C, I, N, and R.

For C, N, and R Status Codes:

  1. Use the CMS Relative Value Units (RVUs) to calculate reimbursements.
  2. When there is no RVU assigned, services are reimbursed By Report.

For I Status Codes:

  1. The service or product is reimbursed according to the CPT code.
  2. If an HPCPCS “J” code is used, the code is reimbursed according to section 9789.13.2.

If the above is nonapplicable:

  1. Use the RVUs to calculate reimbursements.
  2. If the above is not applicable, refer to the regulations in sections 9789.30 - 9789.70.
  3. If both of the above are not applicable, the code is payable By Report.

California Code of Regulations (CCR)

§ 9789.12.3 Status Codes C, I, N and R

Division of Workers’ Compensation Websites

Official Medical Fee Schedule

DaisyBill Resources

Technology is your friend when it comes to calculating correct fee schedule reimbursements. DaisyBill’s OMFS Calculator makes determining accurate reimbursements quick and hassle-free for current AND past dates of service.

Click below to sign up for a free trial of the DaisyBill OMFS Calculator.

Try the DaisyBill OMFS Calculator

Was this article helpful?

About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

Drop us a line with any news you would like us to share or any issue that concerns you.

Read more

Search results for: